Conditional Payment / Medicare Lien Services
A Medicare lien demonstrating conditional payments made by Medicare requires all parties to settlement reimburse the Medicare program for payment on past medical services rendered to a beneficiary that were the responsibility of a third-party.
Conditional payments made by Medicare deemed unrelated to the claim can be formally disputed at a client's request in writing to the Centers for Medicare and Medicaid Services.
PlanPoint conducts conditional payment investigation, analysis, and disputes.
In 1980, Congress passed legislation that forged the path for Medicare Secondary Payer Compliance or 'MSP'. Congress set out to make Medicare the 'secondary payer' to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying.
The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage. Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services.
Medicare Secondary Payer Compliance or 'MSP'), in short, is a process ensuring that, as a party to settlement, you are not knowingly making Medicare the primary payer for medical services that would otherwise be paid for by proceeds from settlement.
A Medicare Set Aside or "MSA" is an integral part of Medicare Secondary Payer Compliance. The MSA a document that considers future medical care and apportions the projection of costs therein from proceeds of settlement and includes only future medical services which are considered to be compensable by Medicare. The MSA is a vehicle that quantifies and projects reasonable consideration of Medicare's interests at time of settlement.
PlanPoint continues to operate with nearly three decades of MSP experience, and executes all facets of Medicare Secondary Payer Compliance including entitlement investigation, MSA reporting, conditional payment services, and MSA submission for approval with Medicare.
Medical Cost Projections
A Medical Cost Projection or "MCP" is acquired for the specific purpose of identifying the future medical needs and associated costs pertaining to a specific injury claim. No two Medical Cost Projections are alike. The MCP compiles and estimates a total future medical claim value relative to the current course of treatment while it considers any recommendations made by actively treating providers.
The Medical Cost Projection is a document that provides an estimate of items and services that an injured or disabled person will, in all probability, require. The MCP is an impartial, third-party estimate of the costs associated with future medical treatment and includes costs associated with procedures, therapies, medications, durable medical equipment, or other related service stemming from an injury, illness, or condition.
This report is commonly sought by PlanPoint customers for use with reserving, mediation, and settlement negotiations. Please note that the Medical Cost Projection is not suitable for litigation, nor is it to be used for the basis of testimony.
For litigation purposes, a Life Care Plan is the recommended practice. The Life Care Plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs.
Should you have questions about Medical Cost Projections or Life Care Plans, PlanPoint has your solutions. Reach out here.